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Gold, incentives and meh

Landmark contract deal cuts QOF by 40% and boosts global sum - but will force GPs to publish their pay

GP practices will have their QOF work slashed by almost 40% next year as part of a sweeping new contract deal which will increase the value of the global sum, create a new emergency admissions DES and see GPs forced to publish their net pay.

Under the new deal, practices will see 341 out of 900 QOF points removed from the framework - the equivalent of £54,000 for the average practice - with the majority reinvested in core GP funding.

But in return, GPs will have to accept ‘named GP’ responsibility for all patients aged 75 years and older, publish their net income from 2015 and commit to police the care their patients receive from out-of-hours providers.

Seniority payments will be reduced by 15% each year and eventually phased out and practice boundaries will be abolished completely in October 2014, although practices will not have responsibility for home visits for patients out of their catchment area.

Some 238 points (£37,000 for the average practice) will be reinvested in the global sum, and a further 100 points (£16,000 for the average practice) from the axing of the quality and productivity domain in QOF, will be ploughed into into a new ‘inappropriate hospital admissions’ DES. Three points will be invested in the learning disabilities DES.

The new DES will mean GPs will have to case-manage vulnerable patients and allow emergency providers to contact GPs to decide whether patients should be admitted to hospital or A&E.

Practices will have to publish the ‘full net income’ of their GPs from 2015, in line with the Government’s drive on transparency on public sector pay. But the BMA said that any changes would only be made alongside other healthcare professions.

A statement said: ‘We have negotiated the establishment of a working group to ensure that the calculation and publication of earnings are on a like-for-like basis with other healthcare professionals and that the published earnings would be GP NHS net earnings relating to the contract only.’

The main thrust of the changes to the GMS contract for 2014/15 are:

  • Reducing the size of the QOF by 341 points, with 238 QOF points being put into the global sum;
  • A new DES to prevent patients being inappropriately admitted to hospital, with an overall budget of £162m. This will replace the current risk-profiling DES, with extra funding from the removal of 100 QOF points from the quality and productivity domain;
  • Practices will have to publish the full net income of their GPs from 2015;
  • Complete abolition of practice boundaries from October 2014, although NHS England local area teams will take responsibility for the home visits of patients from out-of-area patients,
  • A new contractual obligation for GPs to monitor the quality of out-of-hours services when used by their patients and report any concerns;
  • Reduction of seniority payments by 15% each year, with no new entrants from April next year;
  • ‘Named GPs’ will take on accountability for patients over the age of 75, to be the main point of call for providers outside the practice;
  • Practices will have to display the result of their CQC inspection in the waiting room;
  • The introduction of the Friends and Family test from December 2014 asking patients how likely they are to recommend a GP practice;
  • The introduction of new IT systems including the ability for patients to book appointments online and access their Summary Care Record

GPC chair Dr Chaand Nagpaul said that the new deal would deliver real benefit to patients and help ease the pressures on GPs.  

He said: ‘The BMA believes that through constructive talks we have reached an acceptable deal that will help to relieve workload pressures on GPs and is a first step towards enabling general practice to meet the challenges that it faces in the coming years.’

RCGP chair Professor Clare Gerada said: ‘This is welcome news for patients and for GPs as it will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking.’

Dr Peter Swinyard, chair of the Family Doctor Association, also broadly welcomed the deal, but he warned that the ‘devil is in the detail’.

He said: ‘I think this is a good deal for GPs as it will take off many of the things we have been arguing about for the past year or two. It will reverse some of the complete daftness of the contract imposition from last spring and it will allow GPs to have a little more headroom to look after people and start planning care rather than spending their entire lives ticking boxes or going through their colleagues’ notes to check boxes were ticked.’

Dame Barbara Hakin, chief operating officer and deputy chief executive at NHS England, said: ‘As a GP myself for many years, I know the importance of being able to do what we have been trained for - to use our professional clinical judgment to provide care and treatment that meets all aspects of a patient’s needs.’

‘We know that patients who receive a proactive and coordinated health and social care service are less likely to need to be admitted to hospital. In fact a fifth of hospital admissions could be avoided if this happened every time, and we know that this is particularly important for the most vulnerable patients with complex needs where properly coordinated care makes such a difference.’

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Readers' comments (74)

  • T Roscoe

    Nothing on the BMA web site about PMS practices getting this.

    Bet they don't.

    No practice boundaries is going to be interesting

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  • What will happen when there are a high percentage of over 75s on your list? Are they a going to be a help or a liability to income?

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  • Interesting to hear from our cohort of pessimist GP colleagues, I suspect that there will always be pessimism, no matter how well a contract has been negotiated. This is a true win-win for patients ( especially the old and vulnerable), GPs and Jeremy Hunt. Everyone has successfully achieved the best deal.
    From a GPs perspective , a big well done and congratulations to Chaand Nagpaul and the GPC team on negotiating such a sensible deal. Considering that we are in times of austerity with a dearth of resources, it would have been tempting for Jeremy Hunt and the treasury to have pressurised for a significant clawback . The GPC team have done well to highlight the folly of pushing GPs beyond breaking point and have negotiated what appears to be a sensible list of changes . Well done on getting rid of ridiculous aspects of the QoF. The changes described are a basic revision that most of us as GPs would have recommended anyway. The DESs should hopefully be the correct vehicle to allow JH to pursue some of the more complicated areas.it would be helpful for CCGs to strengthen and value the ability of Primary care units by opening up more admission and in- necessary referrals busting community based initiatives that are resourced from CCG budgets through LESs or other innovative vehicles. The CCG development team at NHSE need to stimulate/enable CCGs to divert reduced admission/ referrals funding initiatives to Primary care "gatekeepers". We can all learn to deal with "conflict" related issues as they arise. The GP contract should not always be seen as the main vehicle to seek reductions in A&E attendances and other secondary care activity.

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  • Having left the UK 2 months ago this does NOT make me want to return anytime soon --- either put up or shut up - I left a profession with no integrity who complain about changes but never unite in protestation about the demolition of the profession. No backbone - shameful.

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  • Strike or take it, it's simple, it's another paycut and gloom for us gp's aged 30's - another deal done for the oldies...........

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  • I think I will reduce our practice area significantly, as the patient can stay with me and somebody else can do the visits! Lovely!

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  • Bob Hodges

    I'm in my 30s, and have just started getting seniority payments, so I guess that I crossed the drawbridge just in time but I'll look forward to a big pay cut when I'm 44.

    I will still be looking to drop from 8 session per week to 6 sessions and look to expand my portfolio of better paid, less stressful and more interesting work in OOH, commissioning and the private sector.

    I don't see why the choice should be 'yes' or 'strike'.

    The GPC should be working on alternatives and not take 'defend NHS at all costs' line as the default position. We cannot give informed consent without reference to the alternatives.

    GUERNSEY OPTION DISCUSSION NOW!

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  • More shuffling the deck chairs on the titanic. Will this really make a difference for the frailest patients? Of course we were all neglecting them before this contract change! Policing OOH??? Has anyone ever seen a colleague make a mistake? Have any of us ever made mistakes? Were we always right? Its so frustrating that we have to negotiate with politicians who don't understand medicine and health? What the NHS really needs is less meddling. Sadly it will never happen.

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  • removal of practice boundaries, roll on the private providers cherry picking patients. This 'negotiation' is far worse then expected. 'named responsibility' will carry huge legal consequences and we haven't negotiated a discount on the medical legal cover.

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  • Why on earth do we have to publish our pay Dr Nagpaul? How is that a good thing?

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